Papers by Giuseppe Lamola
European journal of physical and rehabilitation medicine, Jan 29, 2018
Neurophysiological investigations represent powerful tools to shed light on brain plasticity in M... more Neurophysiological investigations represent powerful tools to shed light on brain plasticity in Multiple Sclerosis (MS) patients. We investigated the relationship between EEG-based connectivity, the extent of brain lesions and changes in motor performance after an intensive task-oriented circuit training (TOCT). Observational longitudinal study. Sixteen MS patients (10F; mean age = 51.4 years; range: 27 - 67; mean disease duration = 15.1 years; range: 2 - 26; mean Expanded Disability Status Scale 4.4; range: 3.5 - 5.5), were included in our study. Outpatients training program. MS patients with mild gait impairment were evaluated through functional scales and submitted to TOCT. Resting-state EEG was performed before (T0) and after (T1) rehabilitation. Alpha-band weighted Phase Lag Index (wPLI) and broadband weighted Symbolic Mutual Information (wSMI) connectivity analyses were performed. White matter lesion load was measured using MRI prior to the TOCT. Neurophysiological and structu...
Frontiers in Human Neuroscience
Frontiers in cellular neuroscience, 2017
Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, wh... more Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, which is associated with limited, spontaneous restoration of function. A better understanding of this plastic remodeling is crucial to develop more effective strategies for stroke rehabilitation. In this review article, we discuss advances in the comprehension of post-stroke network reorganization in patients and animal models. We first focus on rodent studies that have shed light on the mechanisms underlying neuronal remodeling in the perilesional area and contralesional hemisphere after motor cortex infarcts. Analysis of electrophysiological data has demonstrated brain-wide alterations in functional connectivity in both hemispheres, well beyond the infarcted area. We then illustrate the potential use of non-invasive brain stimulation (NIBS) techniques to boost recovery. We finally discuss rehabilitative protocols based on robotic devices as a tool to promote endogenous plasticity and fun...
Frontiers in Human Neuroscience, 2016
Various degrees of neural reorganization may occur in affected and unaffected hemispheres in the ... more Various degrees of neural reorganization may occur in affected and unaffected hemispheres in the early phase after stroke and several months later. Recent literature suggests to apply a stratification based on lesion location and to consider patients with cortico-subcortical and subcortical strokes separately: different lesion location may also influence therapeutic response. In this study we used a longitudinal approach to perform TMS assessment (Motor Evoked Potentials, MEP, and Silent Period, SP) and clinical evaluations (Barthel Index, Fugl-Meyer Assessment for upper limb motor function and Wolf Motor Function Test) in 10 cortical-subcortical and 10 subcortical ischemic stroke patients. Evaluations were performed in a window between 10 and 45 days (t0) and at 3 months after the acute event (t1). Our main finding is that 3 months after the acute event patients affected by subcortical stroke presented a reduction in contralateral SP duration in the unaffected hemisphere; this trend is related to clinical improvement of upper limb motor function. In conclusion, SP proved to be a valid parameter to characterize cortical reorganization patterns in stroke survivors and provided useful information about motor recovery within 3 months in subcortical patients.
Biosystems & Biorobotics, 2016
Journal of NeuroEngineering and Rehabilitation, 2015
Background: Forefoot ulcers (FU) are one of the most disabling and relevant chronic complications... more Background: Forefoot ulcers (FU) are one of the most disabling and relevant chronic complications of diabetes mellitus (DM). In recent years there is emerging awareness that a better understanding of the biomechanical factors underlying the diabetic ulcer could lead to improve the management of the disease, with significant socioeconomic impacts. Our purpose was to try to detect early biomechanical factors associated with disease progression. Methods: Thirty subjects (M/F: 22/8; mean age ± SD: 61,84 ± 10 years) with diagnosis of type II DM were included. The participants were divided into 3 groups (10 subjects per group) according to the stage of evolution of the disease: Group 1, subjects with newly diagnosed type II DM, without clinical or instrumental diabetic peripheral neuropathy (DPN) nor FU (group called "DM"); Group 2, with DPN but without FU (group called "DPN"); Group 3, with DPN and FU (group called "DNU"). All subjects underwent 3-D Gait Analysis during walking at self-selected speed, measuring spatio-temporal, kinematic and kinetic parameters and focusing on ankle and foot joints. The comparative analysis of values between groups was performed using 1-way ANOVA. We also investigated group to group differences with Tukey HSD test. The results taken into consideration were those with a significance of P < 0,05. 95 % confidence interval was also calculated. Results: A progressive and significant trend of reduction of ROM in flexion-extension of the metatarso-phalangeal joint (P = 0.0038) and increasing of step width (P = 0.0265) with the advance of the disease was evident, with a statistically significant difference comparing subjects with recently diagnosed diabetes mellitus and subjects with diabetic neuropathy and foot ulcer (P = 0.0048 for ROM and P = 0.0248 for step width at Tukey's test). Conclusions: The results provide evidence that foot segmental kinematics, along with step width, can be proposed as simple and clear indicators of disease progression. This can be the starting point for planning more targeted strategies to prevent the occurrence and the recurrence of a FU in diabetic subjects.
International Journal of Neurorehabilitation, 2015
Lecture Notes in Computer Science, 2016
IEEE transactions on haptics, Jan 30, 2015
This paper presents a novel electromyography (EMG)-driven hand exoskeleton for bilateral rehabili... more This paper presents a novel electromyography (EMG)-driven hand exoskeleton for bilateral rehabilitation of grasping in stroke. The developed hand exoskeleton was designed with two distinctive features: (a) kinematics with intrinsic adaptability to patient's hand size, (b) free-palm and free-fingertip design, preserving the residual sensory perceptual capability of touch during assistance in grasping of real objects. In the envisaged bilateral training strategy, the patient's non paretic hand acted as guidance for the paretic hand in grasping tasks. Grasping force exerted by the non paretic hand was estimated in real-time from EMG signals, and then replicated as robotic assistance for the paretic hand by means of the hand-exoskeleton. Estimation of the grasping force through EMG allowed to perform rehabilitation exercises with any, non sensorized, graspable objects. This paper presents the system design, development, and experimental evaluation. Experiments were performed wit...
Archives italiennes de biologie, 2014
Through plasticity the brain is able to change its function and to rearrange following injury or ... more Through plasticity the brain is able to change its function and to rearrange following injury or environmental changes. In recent years, it was shown that non-invasive brain stimulation (NIBS) techniques, especially transcra- nial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) can contribute to understand how these plastic changes occur. Additionally, the literature suggests that TMS and tDCS may be used as interven- tional strategies to improve neurorehabilitation efforts and arguably recovery of motor function after brain lesions. This review focuses on the use of NIBS in experimental protocols for evaluation and modulation of brain plastic- ity, the factors contributing to the inter-individual variability of response, proposed mechanisms and difficulties in translating findings from small proof of principle studies through the pipeline to clinical practice.
Archives italiennes de biologie, 2014
Emerging findings deriving from neuromodulation and neuroradiology are providing us new insights ... more Emerging findings deriving from neuromodulation and neuroradiology are providing us new insights about plas- ticity and functional reorganization of the brain after stroke, but the direct clinical assessment of motor function should still be considered an indispensable tool for the evaluation of the effects of plasticity in stroke patients. Recovery of motor function can be spontaneous or guided by training. Substantial functional recovery can occur spontaneously especially in the first month post-stroke. Instead, the guided recovery may take more time and may rely on a number of rehabilitation techniques which proved to be capable of stimulating cerebral plasticity. Even the time course of these processes is a decisive element. First, it is important to correlate the trends of plasticity after stroke, from the enhancement of earlier periods to the later stages, to the behavioral changes observed. Furthermore, it is crucial to distinguish recovery of function occurring through impro...
IEEE transactions on haptics, Jan 30, 2015
This paper presents a novel electromyography (EMG)-driven hand exoskeleton for bilateral rehabili... more This paper presents a novel electromyography (EMG)-driven hand exoskeleton for bilateral rehabilitation of grasping in stroke. The developed hand exoskeleton was designed with two distinctive features: (a) kinematics with intrinsic adaptability to patient's hand size, (b) free-palm and free-fingertip design, preserving the residual sensory perceptual capability of touch during assistance in grasping of real objects. In the envisaged bilateral training strategy, the patient's non paretic hand acted as guidance for the paretic hand in grasping tasks. Grasping force exerted by the non paretic hand was estimated in real-time from EMG signals, and then replicated as robotic assistance for the paretic hand by means of the hand-exoskeleton. Estimation of the grasping force through EMG allowed to perform rehabilitation exercises with any, non sensorized, graspable objects. This paper presents the system design, development, and experimental evaluation. Experiments were performed wit...
ABSTRACT This paper presents the results of the evaluation training performed in a group of chron... more ABSTRACT This paper presents the results of the evaluation training performed in a group of chronic stroke patients with Light-Exoskeleton device. The rehabilitation treatment included passive, assisted and active reaching exercises based on a impedance control strategy with gain modulated by the patient&#39;s ability to perform the task. The effects of training were assessed both by means of clinical evaluation in terms of Fugl-Meyer and Modified Ashworth assessment scales, and of functional evaluation, by means of Bimanual Activity test. Moreover, at each session an automatic assessment of performance was made through two robotic measures (task time and smoothness of movement), and these were analysed in term of correlation with the outcome of functional evaluation. Interestingly we found a significant improvement of both clinical and functional evaluation, and that the automatic assessment performed by the robot in terms of smoothness represents a strong predictor of transfer of functional ability to activity of every day life. The high correlation observed between functional outcome and robotic measures suggest the last ones can provide a rapid and useful feedback about the patient&#39;s recovery progress, in addition to the pre- and post-clinical and functional measurements.
Case Reports in Neurological Medicine, 2014
Treatment options for dystonia are not curative but symptomatic; the treatment of choice for foca... more Treatment options for dystonia are not curative but symptomatic; the treatment of choice for focal dystonias is repeated botulinum toxin injections. Here, we present the case of a 46-year-old beautician with focal dystonia in her left hand that affected her ability to work. Pharmacological treatment with clonazepam and gabapentin failed to resolve her symptoms and was discontinued due to side effects (sleepiness, gastrointestinal disorders). Intramuscular injection of botulinum toxin (incobotulinumtoxinA, Xeomin) into the extensor digitorum communis (35 U), flexor carpi radialis (35 U), and flexor digitorum superficialis (30 U) muscles resulted in complete resolution of symptoms at clinical assessments at 1, 3, 6, and 10 months after the injections, confirmed by the results of surface electromyography 10 months after treatment. The patient was able to work again 1 month after treatment. No reinjection has been necessary at the last evaluation (12 months after treatment). In conclusion, botulinum toxin is an effective treatment for focal dystonia that can have long-lasting effects and can improve patients' ability to work and quality of life.
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Papers by Giuseppe Lamola